吹气球法心肺功能锻炼对胃癌患者术后肺部并发症的影响

The effect of balloon blowing on postoperative pulmonary complications in gastric cancer patients

目的:研究术前心肺功能锻炼与胃癌患者术后肺部并发症的相关性,探究针对胃癌患者有效可行的术前干预措施。方法:选取2014年7月至2019年2月期间在温州医科大学附属第一医院就诊的928例胃癌患者,根据患者是否开展术前心肺功能锻炼分为干预组(386例)和对照组(542例),收集患者临床病理特征与术后短期并发症发生情况。通过χ2检验及多因素logistics回归分析,研究肺部相关并发症的独立危险因素。结果:干预组和对照组患者性别、TNM分期组成和Ⅱ级以上术后并发症差异有统计学意义(P<0.05),而年龄、BMI、合并症、NRS-2002评分、肿瘤位置、术前贫血等差异无统计学意义(P>0.05)。干预组呼吸系统相关并发症发生率较对照组显著降低(7.77%vs.14.39%,P=0.001),其中胸腔积液(4.40%vs.8.67%,P=0.004)和肺部感染(3.89%vs.7.56%,P=0.032)的发生率均显著低于对照组。多因素logistics回归分析提示未进行术前心肺功能锻炼的患者肺部并发症发生率较锻炼组升高约两倍(OR=2.161,95%CI=1.371~3.407,P=0.001)。结论:术前进行吹气球等心肺功能锻炼措施能有效减少术后肺部并发症的发生,改善患者短期预后。

Objective:To study the correlation between preoperative cardiopulmonary exercise and postoperative pulmonary complications in patients with gastric cancer,so as to explore effective and feasible preoperative intervention measures for patients with gastric cancer.Methods:A total of 928 gastric cancer patients who underwent an operation in the First Affiliated Hospital of Wenzhou Medical University from July 2014 to February 2019 were selected.They were divided as intervention group(386 cases)and control group(542 cases)depending whether preoperative cardiopulmonary function exercise was performed.The clinicopathological characteristics of the patients and the occurrence of short-term postoperative complications were retrospective collected.Chi square test and multivariate logistic regression was used to analyze and identify independent risk factors for pulmonary complications.Results:There were significant differences in gender,TNM staging composition and postoperative complications(grade II above)between the intervention group and the control group(P<0.05),while no statistical differences were shown in other general information such as age,BMI,complications,NRS-2002 score,tumor location,and preoperative anemia(P>0.05),indicating that the data between the two groups were comparable.The incidence of respiratory complications in the intervention group was significantly lower than that in the control group(7.77%vs.14.39%,P=0.001),and the incidence of pleural effusion(4.40%vs.8.67%,P=0.004)and pulmonary infection(3.89%vs.7.56%,P=0.032)showed the similar result.Multivariate logistic analysis suggested that the incidence of pulmonary complications in patients who did not perform preoperative pulmonary function exercise was twice as high as that in the exercise group(OR=2.161,95%CI=1.371-3.407,P=0.001).Conclusion:Preoperative cardiopulmonary function exercises such as balloon blowing can effectively reduce the incidence of postoperative pulmonary complications and improve the shortterm prognosis of the patients.